<!DOCTYPE html>
<html>
<head>
    <meta charset="UTF-8">
    <title>门诊-住院通知单</title>
    <link rel="stylesheet" type="text/css" href="/static/easyui/css/bootstrap/easyui.css">
    <script type="text/javascript" src="/static/jquery/jquery-1.11.3.min.js"></script>
    <script type="text/javascript" src="/static/js/head.js"></script>
    <script type="text/javascript" src="/modules/doctor/hospitalNotice/js/patHospitalNotice.js"></script>
    <script type="text/javascript" src="/static/data/data_operation_quarantine.js"></script>
    <script type="text/javascript" src="/static/data/data_nation.js"></script>
    <script type="text/javascript" src="/static/data/data_clinic_dept.js"></script>
    <script type="text/javascript" src="/static/data/data_charge_type.js"></script>
    <script type="text/javascript" src="/static/data/data_dict_sex.js"></script>
    <script type="text/javascript" src="/static/data/data_marriage_dict.js"></script>
    <script type="text/javascript" src="/static/data/data_admission_situation.js"></script>
    <script type="text/javascript" src="/static/data/data_dict_sex.js"></script>
    <script type="text/javascript" src="/static/data/data_relationship.js"></script>

    <style>
        .fitem label{ width: 100px; }
    </style>
</head>
<body onload="onloadMethod()">
<form id="patHospitalForm" method="post">
    <input type="hidden" name="id" id="id" value="">
        <div class="container width_90">
            <div class="clearfix goh-sign">

        <div class="fitem fitem_pop" style="height: 20px;">
        </div>
        <!--<input type="hidden" name="id">-->
        <div class="fitem fitem_pop">
            <label>
                姓名：
            </label>
            <input name="name" id="name" readOnly="true"
                   class="easyui-textbox"
                   style="width:15%;"/>
            <label>
                性别：
            </label>
            <input  style="width:15%;" class="easyui-combobox"
                        readOnly="true" name="sex" id="sexId">
            <label>
                出生日期：
            </label>
            <input name="dateOfBirth"  id="dateOfBirth" class="easyui-datebox"
                   readOnly="true" style="width:15%;"/>
        </div>

        <div class="fitem fitem_pop">
            <label>
                年龄：
            </label>
            <input name="age"  id="age" style="width:15%;"
                   readOnly="true"  class="easyui-textbox">
            <label>
                民族：
            </label>
            <input style="width:15%;" id="nationId" name="nation" readOnly="true"
                   class="easyui-combobox">
            <label>
                婚姻：
            </label>
            <input id="maritalStatus" name="maritalStatus"  class="easyui-combobox"
                   style="width:15%;"/>
        </div>

        <div class="fitem fitem_pop">
            <label>
                职业：
            </label>
            <input style="width:30%;" name="occupation"
                   class="easyui-textbox">
            <label>
                身份证号：
            </label>
            <input name="idNo" id="idNo" class="easyui-textbox" readOnly="true"
                   style="width:30%;"/>
        </div>
        <div class="fitem fitem_pop">
            <label>
                出生地：
            </label>
            <input style="width:30%;" name="birthPlace" id="birthPlace" readOnly="true"
                   class="easyui-textbox"
                    >
            <label>
                儿童：
            </label>
            <input name="children" type="checkbox" value="1" />
        </div>
        <div class="fitem fitem_pop">
            <label>
                工作单位：
            </label>
            <input name="serviceAgency" class="easyui-textbox"
                   style="width:30%;"/>
            <label>
                电话：
            </label>
            <input name="serviceAgencyPhone" id="serviceAgencyPhone"  class="easyui-validatebox" data-options="validType:'mobile'"
                   style="width:30%;"/>
        </div>
        <div class="fitem fitem_pop">
            <label>
                现住址：
            </label>
            <input name="insuranceAera"
                   class="easyui-textbox" style="width:30%;"/>

            <label>
                入院日期：
            </label>
            <input name="admissionDateTime" id="visitDate" class="easyui-datebox"
                   style="width:15%;"/>
        </div>
        <div class="fitem fitem_pop">
            <label>
                联系人：
            </label>
            <input name="nextOfKin" id="nextOfKin" class="easyui-textbox"
                   style="width:30%;"/>
            <label>
                关系：
            </label>
            <input name="relationship"  id="relationship" class="easyui-textbox"
                   style="width:15%;"/>
        </div>
        <div class="fitem fitem_pop">
            <label>
                联系人地址：
            </label>
            <input name="nextOfKinAddr" id="nextOfKinAddr" class="easyui-textbox"
                   style="width:30%;"/>
            <label>
                联系人电话：
            </label>
            <input name="insuranceAeraPhone" id="nextOfKinPhone"  class="easyui-validatebox" data-options="validType:'mobile'"
                   style="width:30%;"/>

        </div>
        <div class="fitem fitem_pop">
            <label>
                预交住院费：
            </label>
            <input  name="prepaidFee"  class="easyui-validatebox" data-options="validType:'intOrFloat'"
                    style="width:15%;"/>元
            <label>
                入院情况：
            </label>
            <input   id="patAdmCondition" class="easyui-textbox" name="patAdmCondition"
                     style="width:15%;"/>
            <label>
                入院科室：
            </label>
            <input name="deptAdmissionTo" id="visitDept" class="easyui-combobox"
                   style="width:15%;"/>

        </div>
        <div class="fitem fitem_pop">
            <label>
                发病日期：
            </label>
            <input name="onsetDate" id="onsetDate" class="easyui-datetimebox"
                   style="width:15%;"/>&nbsp;&nbsp;
            <label>
                胎次：
            </label>
            <input name="parityNo"  id="parityNo"class="easyui-combobox"
                   style="width:15%;"/>
        </div>
        <div class="fitem fitem_pop">
            <label>
                注意事项：
            </label>
            <input name="notes" class="easyui-textbox" style="width:70%;"
                    />
        </div>
        <input type="hidden" id="clinicId" name="clinicId" value="">
        <input type="hidden" id="patientId" name="patientId" value="">
        <input type="hidden" id="enterDate" class="easyui-datetimebox" name="enterDate">

        </div>
        </div>
        </form>
    <div id="dlg-buttons" class="btn-save" style="right: 10px;">
        <a href="javascript:void(0)" id="savePatHospitalNotice" class="easyui-linkbutton"  data-options="iconCls:'icon-save'"
        onclick="savePatHospitalNotice();"
        style="width: 90px">保存</a>
    </div>
</body>
</html>